Competing interests

This study was funded by Pfizer Inc. Alesia Sadosky is a full-time employee of Pfizer Inc. and owns stock in the company. The analyses were conducted by Ariel Berger and Gerry Oster, employees of Policy Analysis, Inc. Policy Analysis, Inc. received financial support from Pfizer, Inc. for the conduct of this analysis and development of this manuscript. Drs. Kevin Bozic and Brett Stacey did not receive any financial support from Pfizer. The funding source did not play a role in the investigation or the interpretation of the results.

Authors' contributions

KB, BS, AB, AS, GO designed the study. AB and AS gathered the data. KB, AB, AS, analyzed the data. KB, BS, AB, AS, GO wrote the initial draft. KB, BS, AB, AS, GO ensured the accuracy of the data and analysis. All authors read and approved the final manuscript.

Abstract

Background

The purpose of this study was to compare pre- and post-surgical healthcare costs in commercially insured total joint arthroplasty (TJA) patients with osteoarthritis (OA) in the United States (U.S.).

Methods

Using a large healthcare claims database, we identified patients over age 39 with hip or knee OA who underwent unilateral primary TJA (hip or knee) between 1/1/2006 and 9/30/2007. Utilization of healthcare services and costs were aggregated into three periods: 12 months "pre-surgery," 91 days "peri-operative," and 3 to 15 month "follow-up," Mean total pre-surgery costs were compared with follow-up costs using Wilcoxon signed-rank test.

Results

14,912 patients met inclusion criteria for the study. The mean total number of outpatient visits declined from pre-surgery to follow-up (18.0 visits vs 17.1), while the percentage of patients hospitalized increased (from 7.5% to 9.8%) (both p < 0.01). Mean total costs during the follow-up period were 18% higher than during pre-surgery ($11,043 vs. $9,632, p < 0.01), largely due to an increase in the costs of inpatient care associated with hospital readmissions ($3,300 vs. $1,817, p < 0.01). Pharmacotherapy costs were similar for both periods ($2013 [follow-up] vs. $1922 [pre-surgery], p = 0.33); outpatient care costs were slightly lower in the follow-up period ($4338 vs. $4571, p < 0.01). Mean total costs for the peri-operative period were $36,553.

Conclusions

Mean total utilization of outpatient healthcare services declined slightly in the first year following TJA (exclusive of the peri-operative period), while mean total healthcare costs increased during the same time period, largely due to increased costs associated with hospital readmissions. Further study is necessary to determine whether healthcare costs decrease in subsequent years.